2005 Illinois Code - Chapter 320 Aging 320 ILCS 35/ Partnership for Long-Term Care Act.
(320 ILCS 35/1) (from Ch. 23, par. 6801‑1)
Sec. 1.
Short title.
This Act may be cited as the Partnership for Long‑Term Care Act.
(Source: P.A. 87‑163.)
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(320 ILCS 35/5) (from Ch. 23, par. 6801‑5)
Sec. 5.
The Legislature finds that chronic long‑term care illnesses
threaten the health and welfare of millions of families. Furthermore, most
families have no private or public insurance to help pay the catastrophic
expenses of an extended chronic episode requiring home, community, or
institutional long‑term care.
The costs of care during an extended chronic illness are high and force
tens of thousands of Illinoisans annually to spend‑down their income and
savings of a lifetime and become dependent upon public assistance programs.
The State cannot continue as the insurer of last resort for increasing
numbers of middle‑income Illinoisans while at the same time meeting its
obligations to the poor who have no other means of caring for themselves.
The Legislature declares it is in the interest of the people of Illinois
that individuals be encouraged to anticipate their potential long‑term care
needs by purchasing quality private long‑term care insurance policies.
It is the intent of the Legislature that the State establish a
private‑public long‑term care insurance partnership
program in which individuals who purchase private long‑term care insurance
that meets State standards and who sustain extended episodes of chronic
illnesses that exhaust all the benefits of their private insurance be
eligible for continued care by in‑home supportive services and by
the Medicaid program on the basis of specific resource eligibility
requirements.
(Source: P.A. 89‑525, eff. 7‑19‑96.)
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(320 ILCS 35/10) (from Ch. 23, par. 6801‑10)
Sec. 10.
Definitions.
"Program" means the long‑term care insurance partnership program established
under this Act.
(Source: P.A. 89‑525, eff. 7‑19‑96.)
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(320 ILCS 35/15) (from Ch. 23, par. 6801‑15)
Sec. 15.
Program.
(a) The Department on Aging, in cooperation with the Department of
Insurance, and the Department of Public Aid,
shall administer the program.
(b) The Departments shall seek any federal waivers and
approvals
necessary to accomplish the purposes of this Act.
(Source: P.A. 88‑328; 89‑525, eff. 7‑19‑96.)
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(320 ILCS 35/20) (from Ch. 23, par. 6801‑20)
Sec. 20.
Program participant eligibility for Medicaid.
(a) Individuals who participate in the program and have resources
above the eligibility levels for receipt of medical assistance under Title
XIX of the Social Security Act (Subchapter XIX (commencing with Section
1396) of Chapter 7 of Title 42 of the United States Code) shall be eligible
to receive in‑home supportive service benefits and Medicaid benefits through
the Department of Public Aid if, before becoming eligible for benefits, they
have purchased a long‑term care insurance policy covering long‑term care that
has been certified by the Department of Insurance under
Section 30 of this Act.
(b) Individuals may purchase certified long‑term care insurance policies
which cover long‑term care services in amounts equal to the resources they wish
to protect.
(b‑5) An individual may purchase a certified long‑term care insurance
policy which protects an individual's total assets. To be eligible for
total asset protection, an amount equal to the average cost of 4 years of
long‑term care services in a nursing facility must be purchased.
(b‑7) Although a resource has been protected by the Partnership Policy,
income is to be applied to the cost of care when the insured becomes Medicaid
eligible.
(c) The resource protection provided by this Act shall be effective only
for long‑term care policies which
cover long‑term care services, that are delivered, issued for delivery, or
renewed on or after July 1, 1992.
(d) When an individual purchases a certified long‑term care insurance
policy, the issuer must notify the purchaser of the benefits of purchasing
inflation protection for the long‑term care insurance policy.
(e) An insurance company may offer for sale a policy as described in
paragraph (b) of this Section or paragraph (b‑5) of this Section or both
types of policies.
(Source: P.A. 89‑507, eff. 7‑1‑97; 89‑525, eff. 7‑19‑96; 90‑14, eff.
7‑1‑97.)
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(320 ILCS 35/25) (from Ch. 23, par. 6801‑25)
Sec. 25.
Protection of resources.
(a) Notwithstanding any other provision of law, the
resources, to the extent described in subsection (b), of an
individual who
(i) purchases a certified long‑term care insurance policy which covers
long‑term care services and (ii) has
received all the benefit payments that are payable under that policy or
contract for items described in subsection (b) shall not be
considered in determining:
(1) Medicaid eligibility.
(2) The amount of any Medicaid payment.
(3) The amount of any subsequent recovery by the |
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State of payments made for medical services to the extent federal law permits.
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(4) Eligibility for in‑home supportive services.
(5) The amount of any payment for in‑home supportive
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(b) Benefit payments described in subsection (a) must be for one
or
more of the following:
(1) In‑home supportive service benefits and Medicaid
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long‑term care services specified in regulations by the Department of Public Aid.
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(2) Long‑term care services delivered to insured
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individuals in a community setting as part of an individual assessment and case management program provided by coordinating entities designated or approved by the Department on Aging.
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(3) Services the insured individual received while
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meeting the disability criteria for eligibility for long‑term care benefits established by the Departments.
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(Source: P.A. 89‑525, eff. 7‑19‑96.)
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(320 ILCS 35/30) (from Ch. 23, par. 6801‑30)
Sec. 30.
Certification of policies and contracts.
The Department of
Insurance shall certify only long‑term care insurance policies which cover
long‑term care that provide all of the following:
(1) Individual case management by a coordinating |
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entity designated or approved by the Department on Aging.
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(2) The levels and durations of benefits that meet
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minimum standards set by the Department of Insurance.
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(3) A record keeping system including an explanation
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of benefit reports on insurance payments or benefits that count toward Medicaid resource exclusion.
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(4) Approval of the insurance policy by the
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(5) Compliance with any other requirements imposed
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by the Departments through regulations consistent with the purposes of this Act.
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(Source: P.A. 89‑507, eff. 7‑1‑97; 89‑525, eff. 7‑19‑96; 90‑14, eff.
7‑1‑97.)
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(320 ILCS 35/35) (from Ch. 23, par. 6801‑35)
Sec. 35.
(Repealed).
(Source: P.A. 87‑163. Repealed by P.A. 89‑525, eff. 7‑19‑96.)
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(320 ILCS 35/40) (from Ch. 23, par. 6801‑40)
Sec. 40.
Program.
(a) The program shall be designed so
that the estimated aggregate State expenditures for long‑term care services
for individuals participating in the program do not exceed the aggregate
expenditures that would be made for these services under the Medicaid
program in effect prior to the implementation of the
program.
(b) The Department of Insurance shall provide advice and counseling
through
a Health
Insurance Counseling and Advocacy Program to individuals interested in
purchasing long‑term care insurance
that cover long‑term care services certified under this Act.
(c) Insurers shall make available to the insureds the opportunity to
purchase any traditional long‑term care policy offered by the insurer which
has
benefits comparable to the benefits provided by a certified long‑term care
insurance policy provided for under this amendatory Act of 1996. The insurer
shall make these policies available
without requiring evidence of insurability in the event of the termination of
the program.
(Source: P.A. 89‑525, eff. 7‑19‑96.)
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(320 ILCS 35/45) (from Ch. 23, par. 6801‑45)
Sec. 45.
Agency powers; regulations.
(a) The Departments shall adopt
regulations to
implement this Act, including, but not limited to the following:
(1) The population and age groups that are eligible |
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to participate in the program.
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(2) The minimum level of long‑term care insurance
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that must be purchased to meet the requirement of subsection (b) of Section 20 of this Act.
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(3) The amount and types of services that a
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long‑term care insurance policy that includes long‑term care services must cover to meet the requirements of Section 30 of this Act.
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(4) Which coordinating entities are designated or
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approved to deliver individual assessment and case management services to individuals in a community setting as required by subdivision (b)(2) of Section 25 of this Act.
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(5) The disability criteria for eligibility for
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long‑term care benefits as required by subdivision (b)(3) of Section 25 of this Act.
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(6) The specific eligibility requirements for
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receipt of the Medicaid benefits provided for by the program, and the Medicaid benefits for which participants in the program shall be eligible.
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(b) The Departments shall also adopt regulations to
implement this Act, including, but not limited to, regulations which
establish the following:
(1) The specific eligibility requirements for
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in‑home supportive service benefits.
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(2) Those in‑home supportive service benefits for
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which participants in the programs shall be eligible.
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(c) (Blank).
(Source: P.A. 89‑525, eff. 7‑19‑96.)
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(320 ILCS 35/50) (from Ch. 23, par. 6801‑50)
Sec. 50. Task force.
(a) An executive and legislative advisory task force shall be created to
provide advice and assistance in designing and implementing the Partnership for
Long‑term Care Program. The task force shall be composed of representatives,
designated by the director of each of the following agencies
or departments:
(1) The Department on Aging.
(2) The Department of Public Aid.
(3) (Blank).
(4) The Department of Insurance.
(5) The Department of Commerce and Community Affairs
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(now Department of Commerce and Economic Opportunity).
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(6) The Legislative Research Unit.
(b) The task force shall consult with persons knowledgeable of and
concerned with long‑term care, including, but not limited to the following:
(1) Consumers.
(2) Health care providers.
(3) Representatives of long‑term care insurance
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companies and administrators of health care service plans that cover long‑term care services.
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(4) Providers of long‑term care.
(5) Private employers.
(6) Academic specialists in long‑term care and aging.
(7) Representatives of the public employees' and
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teachers' retirement systems.
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(c) The task force shall be established, and its members designated, not
later than March 1, 1993. The task force shall make recommendations to the
Department on Aging concerning the policy components of the program on or
before September 1, 1993.
(Source: P.A. 94‑793, eff. 5‑19‑06.)
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(320 ILCS 35/55) (from Ch. 23, par. 6801‑55)
Sec. 55.
The Director of Aging shall annually report to the
General Assembly regarding the progress of the pilot program established
under Public Act 87‑163 and the permanent program established under this
amendatory Act of 1996. The report regarding the pilot program shall
be provided by January 1 of each year, commencing with
1993 and ending with 1996. The report regarding the permanent program shall
be provided by January 1 of each year, commencing with 1997. The report
shall include the following:
(a) The success in implementing the public and |
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(b) The number and type of insurers and health care
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service plans with policies or contracts certified by the Departments.
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(c) The number, age, and financial circumstances of
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participants in the pilot or permanent program who have purchased certified long‑term care insurance policies which cover long‑term care services.
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(d) The number of individuals seeking consumer
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information services and advice from the Department on Aging under subsection (b) of Section 40 of this Act.
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(e) The number of participants actually receiving
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long‑term care services, Medicaid benefits, and in‑home supportive services provided by the program, and the type of benefits paid under certified policies which cover long‑term care that could count toward Medicaid resource protection.
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(f) Estimates of the impact on present and future
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(g) The cost effectiveness of the program.
(h) A recommendation regarding the continuation of
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The Director of Aging shall report the following information to the General
Assembly on or before March 31, 1998:
(1) For each department or agency set forth in
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subsection (a) of Section 50, the costs of implementing the program and the savings generated by the program.
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(2) The details of the program proposed by the
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Department on Aging and Department of Insurance.
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(3) The nature of any federal waivers or approvals
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sought by the Department on Aging, including any changes in the Medicaid State Plan proposed to the federal Health Care Finance Administration.
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(Source: P.A. 88‑328; 89‑525, eff. 7‑19‑96.)
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(320 ILCS 35/60) (from Ch. 23, par. 6801‑60)
Sec. 60. Administrative costs.
(a) The Department on Aging, in conjunction with the Department of Public
Aid, the Department of Insurance, and the Department of Commerce
and Economic Opportunity, shall submit applications for State or federal grants
or federal waivers, or funding from nationally distributed private foundation
grants, or insurance reimbursements to be used to pay the administrative
expenses of implementation of the program. The Department on Aging, in
conjunction with those other departments, also shall seek moneys from these
same sources for the purpose of implementing the program, including moneys
appropriated for that purpose.
(b) In implementing this Act, the Department on Aging may
negotiate contracts, on a nonbid basis, with long‑term care insurers,
health care insurers, health care service plans, or both, for the provision
of coverage for long‑term care services that will meet the certification
requirements set forth in Section 30 and the other requirements of this Act.
(Source: P.A. 94‑793, eff. 5‑19‑06.)
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